title: Involuntary movement during mastication in patients with long-term facial paralysis reanimated with a partial gracilis free neuromuscular flap innervated by the masseteric nerve.
abstract: BACKGROUND
  Midface reanimation in patients with chronic facial paralysis is not always possible with an ipsilateral or contralateral facial nerve innervating a free neuromuscular tissue transfer. Alternate use of nonfacial nerves is occasionally indicated but may potentially result in inadvertent motions. The goal of this study was to objectively review videos of patients who underwent one-stage reanimation with a gracilis muscle transfer innervated by the masseteric nerve for (1) inadvertent motion during eating, (2) characterization of masticatory patterns, and (3) social hindrance perceived by the patients during meals.
  
  
  METHODS
  Between the years 2009 and 2012, 18 patients underwent midfacial reanimation with partial gracilis muscle transfer coapted to the masseter nerve for treatment of midfacial paralysis. Sixteen patients were videotaped in detail while eating. Involuntary midface movement on the reconstructed side and mastication patterns were assessed. In addition, 16 patients were surveyed as to whether involuntary motion constituted a problem in their daily lives.
  
  
  RESULTS
  All 16 patients videotaped during mastication demonstrated involuntary motion on the reconstructed side while eating. Several unique masticatory patterns were noted as well. Only one of the 16 patients reported involuntary motion as a minor disturbance in daily life during meals.
  
  
  CONCLUSIONS
  All patients with chronic facial paralysis who plan to undergo midface reanimation with a free tissue transfer innervated by the ipsilateral masseter nerve should be told that they would universally have involuntary animation during mastication. Most patients do not consider this a major drawback in their daily lives.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Shai
authors.initials: S
authors.lastname: Rozen
authors.forename: Bridget
authors.initials: B
authors.lastname: Harrison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D020820:Dyskinesias / Q000209:etiology / Q000503:physiopathology*; D005154:Facial Nerve / Q000637:transplantation*; D005158:Facial Paralysis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000294:innervation*; D006801:Humans; D008297:Male; D008406:Masseter Muscle / Q000294:innervation / Q000503:physiopathology* / Q000601:surgery; D008409:Mastication; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods*; D013997:Time Factors; D055815:Young Adult